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PPrree--CCoonnffeerreennccee 22 770011.. HHoommee HHeeaalltthh SSuummmmeerr CCaammpp 22001133
Presented by
Tom Boyd, MBA, CFE Melinda Gaboury, COS-C Principal Chief Executive Officer Boyd & Nicholas, Inc. Healthcare Provider Solutions, Inc. Rohnert Park, CA Nashville, TN [email protected] [email protected] M. Aaron Little, CPA William Simione, III Director Principal BKD, LLP Simione Healthcare Consultants, LLC Springfield, MO Hamden, CT [email protected] [email protected]
Agenda
Sunday, July 28, 2013, 9:00 a.m. – 3:00 p.m.
9:00 a.m. Current Medicare reimbursement issues (Gaboury) 9:25 a.m. Billing oversight and compliance processes (Gaboury) 10:20 a.m. Break 10:35 a.m. Using the Medicare cost report as a management tool (Boyd) 11:05 a.m. Essential management benchmarking data (Little) 12:00 p.m. Lunch 1:00 p.m. Reporting Medicare organizational changes (Boyd) 1:15 p.m. Achieving compliance in organizational changes (Simione) 2:00 p.m. Feasibility analysis practices for business expansion (Simione) 3:00 p.m. Adjourn
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
1
Current Reimbursement Issues
Home Health PreConference 2013
Base rate of $2,860.20 (increase from $2,137.73) BUT– CMS’s proposed rebasing changes are the most complex factor of the new
rule. As stated in the proposed regulation: “rebasing must be phased-in over a four-year period in equal increments.” So, starting with the 2014 proposed HHPPS rule, CMS has chosen to begin this four-year process with a -3.5 percent rebasing adjustment in 2014. This 3.5 percent reduction is based on CMS projection of an average home health margin of 13.63 percent in 2013 (the difference between the average national episode revenue in home health and the average national episode cost) using 2011 Cost Report Data. This data appears to be skewed and is under intense review.
– Labor Rate Increase from 77.082 to 78.535 percent changing the non-labor rate from 22.918 to 21.465 (good for agencies whose wage index is 1.0 or greater)
Proposed 2014 Payment RatesHome Health
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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Proposed 2014 Payment RatesHome Health
• CMS arrived at its CY 2014 proposed case mix weightsby dividing the CY 2013 case mix weights (which arethe same weights as those finalized in the CY 2012rulemaking) by 1.3517.
• To offset the effect of re-setting the case mix weightssuch that the average is 1.00, CMS increased theproposed CY 2014 national, standardized 60-dayepisodic payment rate by the same factor used todecrease the weights (1.3517).
• The proposed rule suggests that the rebasing of theHHPPS payment rates and case mix weights do notrequire a “case-mix creep” adjustment.
Case Mix Weight Changes 2012
Weight Weight Variance
2011 2012 In Payment
1AFKS 0.5827 0.8186 473.27
1AFLS 0.8507 0.9793 229.46
1AFMS 1.0599 1.1401 114.75
2BHLS 2.2074 2.2145 -103.02
2BHMS 2.3445 2.4691 140.91
2CFKS 2.1524 2.0453 -344.30
5CFKS 3.0835 2.7140 -955.30
5CGKS 3.2730 2.8712 -1034.53
5CHKS 3.4872 3.0014 -1225.63
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
3
Case Mix Weight PROPOSED Changes 2014
Weight Weight Proposed
2011 2012 2014
1AFKS 0.5827 0.8186 0.6056
1AFLS 0.8507 0.9793 0.7245
1AFMS 1.0599 1.1401 0.8435
2BHLS 2.2074 2.2145 1.6383
2BHMS 2.3445 2.4691 1.8267
2CFKS 2.1524 2.0453 1.5131
5CFKS 3.0835 2.7140 2.0078
5CGKS 3.2730 2.8712 2.1241
5CHKS 3.4872 3.0014 2.2205
FINAL Proposed2012 2013 2014
HHA $ 51.13 $ 51.79 $ 54.91MSS $180.96 $183.31 $194.34OT $124.26 $125.88 $133.46PT $123.43 $125.03 $132.56SN $112.88 $114.35 $121.23SLP $134.12 $135.86 $144.03
LUPA
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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NonroutineMedical Supplies
Severity Level Points2013 – FINAL
Urban
2014PROPOSED
Urban
1 0 $14.56 $14.53
2 1 – 14 $52.68 $52.45
3 15 – 27 $144.16 $143.82
4 28 – 48 $214.19 $213.67
5 49 – 98 $330.29 $329.49
6 99+ $568.06 $566.69
Non-Routine Medical SuppliesFINAL - 2013
Case-Mix Reform - 2014
• Proposed case-mix refinement–Expanded set of case-mix variables
• 153 case mix groups – weights changed on all
• CMS states that Category 1 codes likely reflect conditions thepatient had prior to the home health admission (for example,while being treated in a hospital setting). Conditions codedunder this category are anticipated to have progressed to a lessacute state, or are completely resolved for the patient to becared for in the home setting, thus meaning that anotherdiagnosis code would likely have been a more accuratereflection of the patient’s condition in the home.
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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Case-Mix Reform - 2014
• CMS proposes to remove Category 2 codes from the HHPPSGrouper based upon clinical judgment that the condition wouldnot require home health intervention, would not impact the homehealth plan of care (POC), or would not result in additionalresource use when providing home health services to thepatient.
• There are 170 ICD-9-CM codes that CMS proposes to removefrom the HHPPS grouper, effective January 1, 2014.
• Finally, the proposed rule confirms that ICD-10-CM diagnosiscodes are set to be adopted by October 1, 2014 for use byentities covered under the Health Insurance Portability andAccountability Act of 1996 (HIPAA), such as home healthagencies.
Therapy – FINAL 2013
• CMS proposes that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed late reassessment.
• CMS proposes that if multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.
• CMS proposes to revise the assessment timing for individuals receiving more than one type of therapy. The reassessment could occur during the 11th, 12th, or 13th
visit for the required 13th visit reassessment and on the 17th, 18th, or 19th visit for the required 19th visit reassessment.
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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New Codes for Billing HHJuly 2013
EFFECTIVE DATE: July 1, 2013 (HH episodes beginning on or after this date.)
IMPLEMENTATION DATE: July 1, 2013
• HHAs must report where home health services were provided on home health claims, using the Q codes:
– Q5001 - HOME
– Q5002 – ASSISTED LIVING FACILITY
– Q5009 – NOT OTHERWISE SPECIFIED
Billing Compliance Oversight
Home Health PreConference 2013
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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Billing Performance
Job Descriptions: Do they exist for all positions? Do Employees have a copy? Do Employees truly understand what they are responsible for? Are positions over/under-staffed?
Develop measures to monitor staff performance Review measures in team meetings Set reasonable expectations/goals Require staff to be accountableDeal with low performanceSet limits for time allowed to perform at these levels
Reward high performance
Who Does What?
Billers – Collectors – Cash Posters –Managers/SupervisorsDo you have separate designations or does
one person wear all four hats?Does each employee understand his/her
responsibilities?Who is the leader/manager/supervisor?Is there required reporting in place to monitor
progress?
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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Prebilling Audit
Audit 100% of Charts Catch Compliance Issues Catch Issues Associated w/PPS Avoid unnecessary denials
Who should conduct these audits? Billing or Clerical Staff are sufficient – it
is not a clinical audit
When do we conduct these audits?End of episode – no need to audit prior to
end of episode or dischargeWhat do you need for audit?
Patient ChartAudit ToolTrial Bill (Pre-bill)
Prebilling Audit
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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Face To Face Compliance Quick Review of 485 All Blanks Completed, Signed & Dated by Clinician Signed & Dated by Physician Supplies ordered on 485
Supplemental Orders Signed & Dated by Physician Clinical Note for every visit Frequency & Duration Match Visits provided Therapy ReAssessment Visits Correct G code usage Supplies billed correctly OASIS transmitted to the state
Prebilling Audit
Recommend that Agencies do the following: Send Billers/Collectors to Billing Workshops at least once per
year Join List Serves/Participate in Webinars/Teleconferences
frequently Have someone in agency closely monitor the Medicare MAC
websites/newsletters Update PreBilling Audit Tools as necessary Have peers within agency randomly pull prebilling audits and
double check the accuracy Billing/Reimbursement Review by Third Party at least every
two years
Recommendations
Pre-Conference 2701. Home Health Summer Camp 2013Current Medicare Reimbursement Issues &Billing Oversight & Compliance Processes
July 28, 2013
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Faculty Contact Info
Melinda A. Gaboury, COS-CChief Financial Officer
Healthcare Provider Solutions, Inc.810 Royal Parkway, Suite 200
Nashville, TN 37214615-399-7499
info@healthcareprovidersolutions.comwww.healthcareprovidersolutions.com
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
1
NAHC Financial Management Conference & Exposition
“Using the Medicare Cost Report for Management Information, Benchmarking
and Competitive Knowledge”
July 28, 2013
701. Home Health Summer Camp 2013
Presented by: Thomas E. Boyd, Principal Boyd & Nicholas, Inc.
Benchmarking & Productivity
Evaluate Your Data
Illuminate the Results
Improve Your Business
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
2
THE MEDICARE COST REPORT CAN BE USED FOR BENCHMARKING DATA
A COMPLETED AND ACCURATE MEDICARE COST REPORT will permit an organization to benchmark their PPS data against the information provided by ALL the cost reports for the nation and for their state.
Management Use of Cost Report
The MCR is NOT just a “compliance” requirement thatmust be filed with CMS but can be a valuable tool toassist in budgeting, pricing and strategic analysis.
Direct and indirect costs by discipline (per hour and per visit)
Fixed and variable costs
Non-routine medical supplies
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
3
NAHC Cost Report Data Compendium (All States)
Item Number: M-083, All States
The NAHC COST REPORT DATA COMPENDIUM is an in-depth analysis of Medicare cost reports filed by home health agencies since the beginning of the HH PPS payment system in October 2000. NAHC has acquired over 20,000 filed cost reports to develop this Compendium. Cost reports contain a wealth of data. For purposes of this compendium, NAHC used data on per unit costs, supply costs, service utilization, and Medicare PPS episodes. In addition, overall HHA cost and revenue data is used to calculate overall financial margins. The geographic location of the HHA and its categorizations also is utilized. The Compendium is a valuable tool for providers of services, consultants, health policy planners, home care advocates, investors, and trade associations looking to gain an understanding of the financial status of home health agencies.
FOIA
Freedom of Information Act
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
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2012 2011 2010
SN 59.31$ 50.70$ 51.94$ PT 86.47$ 81.56$ 67.77$ OT 80.69$ 73.45$ 59.44$ ST 110.64$ 97.42$ 72.84$ MSW 85.54$ 75.98$ 53.66$ HHA 26.42$ 23.77$ 21.63$
Direct Cost Per Visit
Salaries of worksheet A, column 1, lines 6-11, divided by the visits of worksheet S-3 Part 1, column 5, lines 1-6
2012 2011 2010 Nevada National
SN 113.65$ 116.44$ 123.33$ 147.38$ 130.81$ PT 165.70$ 187.34$ 160.90$ 193.70$ 137.11$ OT 154.62$ 168.72$ 141.13$ 180.60$ 135.22$ ST 212.01$ 223.77$ 172.95$ 198.97$ 147.80$ MSW 163.90$ 174.51$ 127.41$ 209.35$ 201.54$ HHA 50.63$ 54.59$ 51.37$ 78.50$ 60.71$
Total Cost Per Visit
Worksheet C, Part 1, column 4, lines 1-6
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
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2012 2011 2010 Nevada National
SN 11.12 11.58 11.51 9.8 9.9PT 4.18 4.18 3.07 3.2 4.1OT 1.35 1.35 0.98 0.8 0.7ST 0.17 0.04 0.07 0.1 0.1MSW 0.23 0.24 0.21 0.2 0.1HHA 2.57 2.44 2.6 2.7 3.9
Statistics - Average Visits Per Episode
Worksheet S-3 Part IV, visits column 7, divided by total episodes of lines 45 & 46 column 7
2012 2011 2010 Nevada National
SN 10.49 10.50 10.41 8.40 8.30PT 4.67 4.62 4.14 3.60 4.70OT 1.47 1.47 1.07 0.90 0.80ST 0.16 0.05 0.08 0.10 0.10MSW 0.25 0.26 0.22 0.20 0.20HHA 2.83 2.61 2.77 3.00 4.10Total 19.87 19.50 18.69 16.10 18.20
Visits Per Full Episode
Worksheet S-3 Part IV visits column 1 divided by total episodes column 1 line 45
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
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Full w/o Outliers
Full with Outliers LUPA PEP
Your Agency 84.83% 3.27% 8.97% 2.65%
Nevada 82.91% 3.22% 10.24% 2.71%
National 80.59% 4.00% 11.38% 2.29%
Episodes By Type
2012 2011 2010 Nevada National
Revenue 3,095.84$ 3,138.47$ 2,734.15$ 2,764.84$ 2,527.78$ Cost 2,369.85$ 2,544.17$ 2,326.04$ 2,149.91$ 2,007.20$ Profit 725.99$ 594.30$ 408.11$ 614.93$ 520.58$ Visits 19.63 19.83 19.07 16.70 19.00
Average Per Episode
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
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2012 2011 2010 Nevada National
3,382.38$ 3,366.64$ 2,967.26$ 3,009.68$ 2,752.65$
Payment Per Full Episode
Worksheet D Part II line 12.01, total of columns 1 & 2 divided by Worksheet S-3 Part IV, column 1 line 45
Full w/o Outliers
Full with Outliers
LUPA PEP Total
Revenue $600,270 $26,195 $14,789 $8,353 $649,607
Cost $444,324 $35,096 $12,822 $5,755 $497,997
Profit $155,946 ($8,901) $ 1,967 $2,598 $151,610
Profit By Episode Type
Cost Report Indicators
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
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• Cost Analysis Capital Costs $ 55,500Plant Operation / Maint $ 10,400Administration $ 464,218 26.48%Total Overhead Costs $ 530,118 30.24%Direct Costs $1,222,646 69.76%Total Costs $1,752,764Total Patient Revenue $1,809,392
Admin Costs as % of Revenue 25.66%
Cost Report Indicators
All Costs from Worksheet A column 10
• Medicare Profit MarginMedicare PPS Reimbursement $649,607
Medicare PPS CostVisit Cost $491,437NRS Cost $ 6,560Total Cost $497,997
Medicare Profit Margin $151,610
Medicare Margin % 23.3%
Cost Report Indicators
PPS reimbursement from Worksheet B Part II total of lines 28 columns 1 & 2
PPS costs from Worksheet C Part IV line 19 column 6
Pre-Conference 2701. Home Health Summer Camp 2013Medicare Cost Report
July 28, 2013
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ZPIC REQUESTS COST REPORT INFORMATIONFROM HOME HEALTH AGENCY
Home Health Alert, Volume 13.03April 10, 2013
www.healthgroup.com
Contact Information
Tom Boyd, MBA, CFEPrincipalBoyd & Nicholas, [email protected]
July 28, 2013
1
Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
CPAs & ADVISORS
Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
M. Aaron Little, CPA
BKD, LLP | [email protected]
July 28, 20139:00 a.m. – 3:00 p.m.Washington, DC
2
OBJECTIVES
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
OBJECTIVESEvaluating home health (HH) performance using key metricsComparing HH performance using key benchmarks
3
4
EVALUATING PERFORMANCE
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
EVALUATING PERFORMANCE
5
Identify• key metrics
Gather• raw performance
data
Measure• performance data
Compare• performance results
Examine• processes driving
performance
Implement• action &
accountability plan
EVALUATING PERFORMANCEIdentify key metrics
Are metrics meaningful, objective & measurable, & comparable?Is data available & obtainable?Are data management requirements sustainable?
Gather raw performance dataInternal data
Billing, accounting & operations systems, CASPER, cost reports, etc.
External dataPublicly available &/or reported data, benchmarking & market analysis vendors, government or advocacy organizations, etc.
6
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
EVALUATING PERFORMANCEMeasure performance data
Are industry benchmarks available?Relevant & comparable to your organization?
Do personnel know how to measure & manage performance data?
Compare performance resultsIs data comparable?
Are data sources comparable?Are time periods measured comparable?
7
EVALUATING PERFORMANCEExamine process drivers
What are processes responsible for performance?What are primary improvement opportunities?How will action plan address opportunities?
Implement action & accountability planWhat are reasonable timelines & performance milestones?What will be used to monitor & manage accountability?With what frequency will performance be monitored?
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July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
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COMPARING PERFORMANCE
COMPARING PERFORMANCEQualityFinancial & cash flowVolumeRevenuesExpensesCompliance
10
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
QUALITYPatient perception & satisfaction
HH Consumer Assessment of Healthcare Providers & Systems (CAHPS) data
Publicly reported & quantifiableAvailable to all Medicare providers
How often HH team gives care in professional way?How well did HH team communicate with patients?Did HH team discuss medicines, pain, & home safety with patients?How do patients rate overall care from HH agency?Would patients recommend HH agency to friends & family?
11
QUALITYOutcome & Assessment Information Set (OASIS) data
OutcomesPublicly reported & quantifiableAvailable to all Medicare providers
How often patients got better at walking or moving around?How often patients got better at getting in & out of bed?How often patients got better at bathing?How often patients had to be readmitted to hospital?
Outcome-Based Quality Improvement & Outcome-Based Quality Monitoring
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July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
0%
20%
40%
60%
80%
Rehospitalization Ambulation Transferring Bathing
Outcomes
13
70%75%80%85%90%
Professionalism Communication Meds, pain,safety
Care rating We'rerecommended
Patient Satisfaction
State
Nation
Per Centers for Medicare & Medicaid Services (CMS) Home Health Compare website
QUALITYOther metrics to consider
Admission response timeReferral intake timeReferral source satisfactionImpact of telemonitoring or other specialty programs, etc.Post-discharge patient activitiesDisease-specific outcomesSpecialty-specific program outcomes
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July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
FINANCIAL & CASH FLOWBenchmark sources
BKD analyzed & compiledMedicare cost report data obtained directly from CMSFreestanding & hospital-based agencies
Excludes skilled nursing facility-based agenciesFiscal years ended in 2011
15
FINANCIAL & CASH FLOWStrategic Healthcare Programs, LLC (SHP) analyzed & compiled
Study conducted by SHP of its user database to determine its Benchmark Leaders
Based on outcomes & compliance indicatorsBenchmarking Leaders financial performance then analyzed by BKD using Medicare cost report data
OCS HomeCare EliteStudy conducted by OCS to determine its HomeCare Elite
Based on outcomes & financial indicatorsTop 100 agencies
HomeCare Elite Medicare cost report data analyzed by BKD
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July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
FINANCIAL & CASH FLOWMargins
Gross marginMargin after direct costsData not available for hospital-based agencies
Medicare marginIncludes traditional Medicare only
Excludes Medicare AdvantageBased on average episode payment & average episode cost
17
FINANCIAL & CASH FLOWOverall margin
Includes all payers & programsHH, hospice, private duty, etc.
Data not available for hospital-based agencies
Cash flowDays in accounts receivable (AR)/days sales outstanding (DSO)Data not available for hospital-based agencies
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
FINANCIAL & CASH FLOW
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Metric Median Best 25% Median Best 25% Median Best 25%Gross margin3 52% 61% 47% 55% 51% 61%Medicare margin 19.7% 29.0% 20.9% 28.3% 10.5% 23.3%Overall margin3 10.5% 19.2% 7.5% 18.4% 2.8% 10.8%Days in AR 52 37 53 41 54 38
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
OCS Top 1001 SHP/BKD1 Nation2
FINANCIAL & CASH FLOWOther metrics to consider
ProfitabilityMargins by program, i.e., HH, hospice, private duty, etc.Margins by payer, i.e., Medicare, Medicaid, commercial, etc.Earnings before interest, taxes, depreciation & amortization (EBITDA)Return on assets
LiquidityCurrent ratioQuick ratioLeverage ratio
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July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
FINANCIAL & CASH FLOWCash flow
Percent of AR older than 90 or 120 daysCollections as a percent of net revenuesWrite-offs as percent of net revenuesAverage days to bill
Medicare requests for anticipated payments (RAPs)Medicare final claimsNon-Medicare claims
21
VOLUMENet revenues
Includes all payers & programsData not available for hospital-based agencies
VisitsIncludes all HH visits
PatientsIncludes all HH unduplicated patientsData not available for hospital-based agencies
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
VOLUMEMedicare patient percentage
Traditional Medicare onlyData not available for hospital-based agencies
Medicare episodesTraditional Medicare only
Medicare revenuesTraditional Medicare only
23
VOLUME
24
Metric Median Best 25% Median Best 25% Median Best 25%Net revenues3 $2.1 mil. $3.5 mil. $3.3 mil. $7.4 mil. $1.4 mil. $3.2 mil.Visits 10,115 16,643 19,263 39,965 9,062 19,432Patients 318 562 949 1,708 250 628Medicare patients3 78% 94% 64% 79% 86% 100%Medicare episodes 461 907 822 1,516 371 772Medicare revenues $1.3 mil. $2.3 mil. $2.2 mil. $3.3 mil. $0.9 mil. $2.0 mil.
OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
VOLUMEOther metrics to consider
Current censusVolume by program & payer & by diagnosis/diseaseNumber of referrals by source & by diagnosis/diseaseNumber of new admissions vs. readmissionsNumber of non-admissionsMarket assessment
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REVENUESVisitsPercent of traditional Medicare visitsMedicare low utilization payment adjustments (LUPAs)Medicare episodes per patientAverage Medicare case-mix weight
Includes full episodes onlyExcludes LUPAs, partial episode payments, & outliers
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
REVENUESAverage therapy visits per Medicare episode
Traditional Medicare onlyIncludes physical therapy (PT), occupational therapy (OT), & speech therapy (ST)Average of all episodes
Average Medicare episode paymentTraditional Medicare onlyIncludes all payment adjustments
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Metric Median Best 25% Median Best 25% Median Best 25%Visits 10,115 16,643 19,263 39,965 9,062 19,432Medicare visits 84% 96% 69% 79% 86% 100%Medicare episodes 461 907 822 1,516 371 772LUPAs 5.1% 2.8% 9.5% 5.1% 6.5% 2.9%Episodes per patient 1.6 2.3 1.3 1.6 1.6 2.3
Case-mix weight 1.3300 1.5395 1.3444 1.4722 1.3133 1.5193Therapy visits per episode 5.1 7.6 5.4 7.2 5.3 7.6Average episode payment $2,648 $3,148 $2,708 $3,141 $2,670 $3,115
REVENUES
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OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 2011
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
REVENUESOther metrics to consider
Revenues by program & payer/plan & diagnosis/diseaseAverage payment per episode per referral/admission sourceAverage payment per visit &/or per patient
For all per-visit payers/plansAverage payment per Medicare episode dimension
Clinical, functional & service utilizationNonroutine medical supplies
Average case-mix weight & payment adjustments per clinician
29
EXPENSESCost per visit
Includes hospital-based overhead
Visits per Medicare episodeIncludes all episodes
Cost per Medicare episodeIncludes hospital-based overhead
Labor costs as a percent of revenuesIncludes compensation, contract labor & benefits
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
EXPENSESAdministrative & general (A&G) costs as a percent of revenuesHours per visit
Includes all personnel hours workedTotal hoursA&G hours
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EXPENSES
32
Metric Median Best 25% Median Best 25% Median Best 25%Cost per visit $125 $101 $136 $116 $136 $106Hours per visit 3.3 2.3 3.0 2.3 3.2 2.5
Visits per episode 16.9 14.5 14.9 13.7 16.9 14.3
Cost per episode $2,196 $1,888 $2,127 $1,900 $2,405 $1,953
Labor percent of revenues3 68% 61% 72% 64% 75% 65%
A&G cost percent of revenues3 36% 32% 35% 26% 39.2% 30%
A&G hours per visit 1.2 0.9 1.2 0.8 1.3 0.9
OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
EXPENSESDiscipline-specific drill-down
Visits per episodeCost per visit
Without hospital-based overheadDirectIndirectHospital-based overhead
Hours per visitVisits per day per full-time equivalent (FTE)
33
EXPENSES
34
Metric Median Best 25% Median Best 25% Median Best 25%Visits per episode 8.4 6.9 7.7 6.5 8.5 6.9Cost per visit3 $142 $97 $135 $118 $137 $107
Direct only $74 $50 $78 $62 $69 $50Indirect $52 $37 $56 $39 $63 $43Overhead $42 $29 $34 $25 $43 $28
Hours per visit 2.3 1.3 2.0 1.5 2.0 1.2Visits per day 3.7 6.9 4.5 5.9 4.5 6.8
Skilled Nursing OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
EXPENSES
35
Metric Median Best 25% Median Best 25% Median Best 25%Visits per episode 4.4 6.2 4.2 5.5 4.3 6.1Cost per visit3 $134 $110 $141 $118 $159 $126
Direct only $72 $60 $81 $70 $83 $69Indirect $54 $34 $56 $37 $72 $46Overhead $30 $18 $32 $25 $36 $24
Visits per day 6.2 9.0 5.5 6.7 6.1 8.7
Physical Therapy OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
EXPENSES
36
Metric Median Best 25% Median Best 25% Median Best 25%Visits per episode 0.5 1.1 1.2 1.8 0.6 1.4Cost per visit3 $135 $107 $139 $113 $158 $124
Direct $77 $60 $76 $64 $80 $64Indirect $55 $31 $59 $38 $73 $47Overhead $26 $16 $31 $24 $37 $24
Visits per day 5.6 8.5 5.3 7.3 5.2 8.4
Occupational Therapy OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
EXPENSES
37
Metric Median Best 25% Median Best 25% Median Best 25%Visits per episode 1.6 0.8 1.4 0.7 1.8 0.8Cost per visit3 $54 $41 $57 $46 $55 $41
Direct $27 $21 $30 $24 $27 $20Indirect $24 $14 $24 $16 $26 $16Overhead $13 $5 $12 $8 $16 $10
Hours per visit 1.9 1.2 1.8 1.2 1.6 1.1Visits per day 4.8 7.2 4.9 6.7 5.5 8.0
Aide OCS Top 1001 SHP/BKD1 Nation2
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Data only available for freestanding agencies
EXPENSESOther metrics to consider
Transportation expensesPer visit, personnel, patient
Costs per referral/admission source & diagnosis/diseaseSupply costs per patient & per diagnosis/diseaseProductivity standards
Per visit vs. per case-load
38
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
COMPLIANCEPayment per episodeCase-mix weightTherapy visits per episodeEpisodes per patientOutliersLUPAsOutcomes
39
COMPLIANCE
40
Metric Provider OCS Top 1001 SHP/BKD1 Nation2
Average episode payment $3,502 $2,648 $2,708 $2,670Case-mix weight 1.8616 1.3300 1.3444 1.3133Average therapy visits per episode 11.5 5.1 5.4 5.3Episodes per patient 1.2 1.6 1.3 1.6Outliers 1.7% 0.4% 0.5% 0.8%LUPAs 6.5% 5.1% 9.5% 6.5%Ambulation3 55% Not available Not available 58%Transfers3 67% Not available Not available 55%Bathing3 70% Not available Not available 66%
1Per BKD study of 2011 Medicare cost report data of OCS HomeCare Elite Top 100 & SHP Benchmark Leaders2Per BKD study of Medicare freestanding & hospital-based cost reports with fiscal years ended in 20113Per CMS Home Health Compare
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
COMPLIANCEOther considerations
Frequency of additional development requests & denialsRegulatory survey resultsProgram integrity actionsPatient &/or personnel complaintsAverage Medicare payment per beneficiaryFrequency of Medicare HIPPS codes
41
42
MANAGING PERFORMANCE
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
0%
50%
100%
Professional care Patient rating Patientrecommendations
Rehospitalizations Ambulation Transfers Bathing
0.00 0.50 1.00 1.50 2.00
Case-mix
LUPAs
Episodes/patient65%
31%4%
Revenue Mix
45%55%
4%
Census Mix
0 5 10 15 20
Skilled
Therapies
Aides
Total
Visits Per Episode0 500 1,000 1,500
Census
YTD non-admits
YTD patients
YTD episodes
$0 $1,000 $2,000 $3,000 $4,000
Pay per episode
Cost per episode
$0 $50 $100 $150 $200
Per-visit revenue
Per-visit cost
0 5,000 10,000 15,000 20,000
YTD visits
YTD non-Medicare
Medicare
Medicare
16%2%
75 days
Us
Them Nation
State
Patient Satisfaction & Clinical Outcomes
43
44
July 28, 2013
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Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
45
46
July 28, 2013
24
Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
CPAs & ADVISORS
Pre-Conference 2701. Home Health Summer Camp 2013Essential Benchmark Data
M. Aaron Little, CPA
BKD, LLP | [email protected]
July 28, 20139:00 a.m. – 3:00 p.m.Washington, DC
Attachment A
Formula Key
Current Ratio = Total Current Assets / Total Current Liabilities Quick Ratio = (Cash + Accounts Receivable) / Total Current Liabilities Gross Profit Margin = Gross Profit / Sales Net Profit Margin = Adjusted Net Profit before Taxes / Sales Inventory Days = (Inventory / COGS) * 365 Accounts Receivable Days = (Accounts Receivable / Sales) * 365 Accounts Payable Days = (Accounts Payable / COGS) * 365 Interest Coverage Ratio = EBITDA / Interest Expense Debt-to-Equity Ratio = Total Liabilities / Total Equity Return on Equity = Net Income / Total Equity Return on Assets = Net Income / Total Assets Fixed Asset Turnover = Sales / Gross Fixed Assets Sales per Employee = Sales / Total Employees (FTE) Profit per Employee = Adjusted Net Profit before Taxes / Total Employees (FTE) Profit Growth = (Current Period Adjusted Net Profit before Taxes - Prior Period
Adjusted Net Profit Before Taxes) / Prior Period Adjusted Net Profit before Taxes
Sales Growth = (Current Period Sales - Prior Period Sales) / Prior Period Sales
Attachment B
Sample Home Care & HospiceOverall Financial Dashboard
Monthly DashboardPrior
Key Performance Indicators Year January February March April May June July August September October November December YTD Target
ProfitabilityContribution Margin %
Home Health 38.0% 40.7% 56.0% 36.9% 48.4% 31.7% 34.9% 47.9% 43.4%
Hospice 29.6% 23.5% 28.2% 30.8% 45.5% 44.7% 35.8% 33.7% 35.8%
Private Duty 24.4% 22.2% 33.0% 33.6% 43.8% 50.1% 38.9% 45.5% 42.2%
Net Profit % -3.3% 4.3% 27.5% -1.3% 35.3% 2.7% 1.3% 10.2% 11.6%
EBITDA % -2.0% 5.7% 28.8% 0.1% 36.5% 3.9% 2.4% 11.0% 12.8%
Return on Assets -4.2% 0.5% 3.2% -0.1% 3.9% 0.3% 0.2% 1.4%
Return on Net Assets -18.6% 2.0% 13.9% -0.6% 15.6% 1.1% 0.6% 5.2%
Cash FlowDays in AR 40.9 47.1 45.7 39.5 39.5 49.9 43.3 45.3
AR over 90 Days 41,096 45,976 53,603 42,552 26,267 15,868 63,839 81,061
Cash Collections as a % of Revenue 79.9% 77.4% 79.0% 106.3% 87.1% 71.3% 60.2% 78.3% 79.2%
Days to RAP Billing 9 7 5 6 4 4 6 4
LiquidityCurrent Ratio 1.57 1.57 1.58 1.68 1.86 1.95 2.10 2.00
Quick Ratio 1.40 1.32 1.35 1.33 1.52 1.58 1.71 1.69
Leverage Ratio 22.5% 22.6% 25.9% 22.3% 20.3% 19.7% 18.8% 22.4%
Sample Home Care & HospiceHome Health Financial Dashboard
Monthly Home Health DashboardPrior
Key Performance Indicators Year January February March April May June July August September October November December YTD Target
VolumeCensus - Beginning of Period 113 122 145 146 122 105 124 113
Admissions 710 97 81 70 76 79 70 86 Discharges 701 74 80 94 93 60 81 68
Census - End of Period 122 145 146 122 105 124 113 131
Non-Medicare Payer Mix 35.3% 39.3% 35.1% 38.7% 29.1% 30.1% 35.6% 34.8% 34.9%
Medicare Recertification Rate 13.6% 26.4% 22.2% 15.8% 19.2% 25.7% 20.1% 9.1% 19.5%
RevenueAvg Medicare Payment per Episode 3,298$ 2,288$ 2,560$ 2,484$ 2,622$ 2,835$ 2,508$ 2,693$ 2,563$
Avg Case Mix Weight 1.3339 1.2287 1.3758 1.4714 1.4439 1.5825 1.3415 1.5188 1.4536
% of Episodes Adjusted 24% 11% 15% 18% 20% 16% 17% 10% 15%
Avg Non-Medicare Payment Per Visit 33.90$ 40.81$ 29.51$ 67.39$ 64.34$ 37.88$ 35.05$ 35.76$ 43.39$
ExpenseGross Profit % 38.0% 40.7% 56.0% 36.9% 48.4% 31.7% 34.9% 47.9% 43.4%
Visits Per Medicare Episode 24.21 17.42 20.60 23.49 21.67 20.73 14.77 19.13 19.67
Overall Direct Cost per Visit 60.51$ 62.12$ 50.17$ 58.09$ 59.21$ 75.05$ 84.15$ 66.96$ 63.45$
Labor as a % of Revenue 85.3% 86.1% 63.8% 90.1% 75.9% 95.3% 93.0% 75.0% 81.2%
Attachment C
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
Number of Agencies Total agencies in peer group data: 88 Total agencies in peer group data: 65 Total agencies in national data: 9,510Service Delivery Dashboards
Total home health visits 5,815 10,115 16,643 11,165 19,263 39,965 4,213 9,062 19,432 Total visits for other services4 - - - - - - - - - Total net patient revenue4 1,161,534$ 2,123,723$ 3,450,816$ 1,914,427$ 3,315,397$ 7,440,538$ 672,662$ 1,445,622$ 3,229,937$ Total Medicare episodes 250 461 907 495 822 1,516 174 371 772 Total Medicare home health revenue 724,736$ 1,252,870$ 2,320,513$ 1,356,623$ 2,172,526$ 3,994,875$ 433,839$ 939,215$ 2,013,330$ Total home health unduplicated patients4 197 318 562 558 949 1,708 105 250 628 Total unduplicated patients for other services4 - - - - - - - - - Payer mix, measured on total visits
Medicare 69.1% 83.4% 95.5% 60.6% 68.5% 80.1% 63.0% 85.7% 100.0%Other 4.5% 16.6% 30.9% 19.9% 31.5% 39.5% 0.0% 14.3% 37.1%
Payer mix, measured on unduplicated patients4
Medicare 63.4% 77.7% 93.5% 53.7% 63.8% 78.7% 61.5% 86.3% 100.0%Other 6.6% 22.3% 36.6% 21.3% 36.2% 46.3% 0.0% 13.7% 38.5%
Visits per Medicare episode (all episodes)Skilled nursing 6.9 8.4 10.4 6.5 7.7 8.9 6.9 8.5 10.6 Physical therapy 2.9 4.4 6.2 3.5 4.2 5.5 2.9 4.3 6.1 Occupational therapy 0.1 0.5 1.1 0.7 1.2 1.8 0.2 0.6 1.4 Speech therapy 0.0 0.1 0.2 0.1 0.1 0.3 - 0.1 0.2 Medical social services - 0.0 0.1 0.1 0.1 0.2 - 0.1 0.1 Home health aide 0.8 1.6 2.8 0.7 1.4 2.2 0.8 1.8 3.8
Total visits per episode 14.5 16.9 18.7 13.7 14.9 17.5 14.3 16.9 20.3 Total therapy visits per episode 3.8 5.1 7.6 4.7 5.4 7.2 3.5 5.3 7.6
Skilled nursing 7.4 8.9 10.7 7.2 8.3 9.6 7.6 9.0 11.2 Physical therapy 3.1 4.7 6.8 3.9 4.7 6.2 3.1 4.7 6.6 Occupational therapy 0.1 0.5 1.2 0.7 1.3 1.9 0.2 0.7 1.5 Speech therapy 0.0 0.1 0.3 0.1 0.2 0.3 - 0.1 0.2 Medical social services - 0.0 0.1 0.1 0.1 0.2 - 0.1 0.2 Home health aide 0.9 1.8 3.3 0.8 1.6 2.4 0.9 2.0 4.1
Total visits per episode 15.7 17.9 20.0 15.0 16.6 19.1 15.5 18.2 21.7 Total therapy visits per episode 4.0 5.6 8.4 5.2 6.1 8.1 3.8 5.8 8.3
Visits per Medicare LUPA episode 2.6 2.8 3.0 2.5 2.7 2.9 2.5 2.7 2.9
Health Care Group | www.bkd.com Questions? Contact M. Aaron Little at [email protected].
1 of 7
BKD Analysis ofOCS HomeCare Elite,
Top 100
Visits per Medicare full episode (including outliers)
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
BKD Analysis ofOCS HomeCare Elite,
Top 100
Service Delivery Dashboards (Continued)Number of episodes per Medicare patient 1.3 1.6 2.3 1.2 1.3 1.6 1.3 1.6 2.3 Estimated number of hours per visit
Direct nursing service (based on SN visits) 1.3 2.3 3.2 1.5 2.0 2.9 1.2 2.0 2.8 Home health aide service (based on HHA visits) 1.2 1.9 2.7 1.2 1.8 2.3 1.1 1.6 2.2 Administrative staff 0.9 1.2 1.7 0.8 1.2 1.4 0.9 1.3 1.9 Total staff 2.3 3.3 4.1 2.3 3.0 3.4 2.5 3.2 4.2
Estimated number of visits per day per FTE5
Direct nursing service 2.7 3.7 6.9 3.2 4.5 5.9 3.2 4.5 6.8 Physical therapy service 4.5 6.2 9.0 4.5 5.5 6.7 4.4 6.1 8.7 Occupational therapy service 4.4 5.6 8.5 4.3 5.3 7.3 3.9 5.7 8.4 Speech therapy service 3.8 5.4 6.9 3.3 5.7 7.7 3.4 5.2 7.6 Medical social services - 0.6 2.8 1.0 2.5 5.4 - 0.7 3.5 Home health aide service 3.1 4.8 7.2 3.9 4.9 6.7 3.8 5.5 8.0
Operating DashboardsCost Per VisitSkilled nursing
Salaries4 33.32$ 58.04$ 73.69$ 49.77$ 60.72$ 74.84$ 35.00$ 51.77$ 69.36$ Employee benefits4 3.68 7.48 10.63 5.85 8.86 15.47 1.28 6.25 10.99 Contract services4 - - 0.16 - - 0.19 - - 1.71
Total labor 47.27 70.86 96.98 57.91 71.47 96.98 47.89 65.72 89.39 Transportation - 0.52 5.56 - 3.56 5.54 - - 4.61 Other direct costs - - - - - - - - -
Total direct care costs 50.05 73.68 100.64 62.17 77.89 102.32 49.66 68.83 94.17 Indirect agency costs 37.25 52.01 82.58 39.41 56.38 67.42 42.91 62.51 90.44
Total agency cost per visit 97.14 141.51 166.78 118.39 135.14 166.44 107.46 136.77 173.54 Provider-based overhead costs3 29.09 41.76 50.59 24.97 33.90 42.54 28.16 42.83 60.16
Total cost per visit 99.56$ 141.96$ 187.30$ 120.32$ 137.40$ 166.44$ 109.24$ 140.10$ 179.86$
Health Care Group | www.bkd.com Questions? Contact M. Aaron Little at [email protected].
2 of 7
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
BKD Analysis ofOCS HomeCare Elite,
Top 100
Operating Dashboards (Continued)Cost Per Visit (Continued )Physical therapy
Salaries4 -$ -$ 50.32$ 27.92$ 50.30$ 61.96$ -$ 2.96$ 57.07$ Employee benefits4 - - 7.62 2.78 7.02 11.27 - - 7.84 Contract services4 0.03 53.83 69.90 2.44 15.19 36.54 4.93 54.64 80.15
Total labor 58.21 71.68 83.61 66.84 76.53 90.16 67.86 80.95 95.15 Transportation - - 1.22 - 1.41 3.83 - - 2.42 Other direct costs - - - - - - - - -
Total direct care costs 60.40 72.28 87.85 70.28 81.37 94.42 69.42 83.01 97.65 Indirect agency costs 34.38 54.29 83.86 36.89 56.45 72.00 46.14 72.02 116.20
Total agency cost per visit 109.95 133.86 161.56 117.98 140.55 165.00 126.32 159.35 206.82 Provider-based overhead costs3 18.45 30.01 47.47 25.20 32.06 44.26 24.31 36.26 50.10
Total cost per visit 113.77$ 140.59$ 167.41$ 120.78$ 142.39$ 168.96$ 130.72$ 163.50$ 210.09$ Occupational therapy
Salaries4 -$ -$ 52.51$ 9.57$ 43.76$ 71.56$ -$ -$ 59.66$ Employee benefits4 - - 8.78 - 5.96 8.69 - - 7.82 Contract services4 - 55.44 75.54 - 3.29 44.10 - 48.50 78.85
Total labor 59.88 72.64 90.40 62.96 74.51 88.09 62.19 79.03 94.20 Transportation - - 0.51 - 0.44 2.85 - - 2.28 Other direct costs - - - - - - - - -
Total direct care costs 60.20 77.05 91.54 64.09 75.81 92.03 63.69 80.17 96.76 Indirect agency costs 31.02 55.12 91.55 38.46 59.31 78.95 46.67 73.03 116.01
Total agency cost per visit 107.06 135.35 176.33 113.31 138.54 167.90 124.03 158.11 203.98 Provider-based overhead costs3 16.39 26.04 39.12 24.02 31.06 36.50 23.87 36.83 52.16
Total cost per visit 112.42$ 135.79$ 182.22$ 114.18$ 142.12$ 174.71$ 127.35$ 161.92$ 207.97$
Health Care Group | www.bkd.com Questions? Contact M. Aaron Little at [email protected].
3 of 7
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
BKD Analysis ofOCS HomeCare Elite,
Top 100
Operating Dashboards (Continued)Cost Per Visit (Continued )Speech therapy
Salaries4 -$ -$ 21.30$ -$ 53.73$ 80.52$ -$ -$ 61.84$ Employee benefits4 - - 0.88 - 4.84 12.17 - - 7.89 Contract services4 - 61.43 87.38 - 4.37 54.49 - 53.18 81.95
Total labor 63.72 76.23 100.69 61.76 77.27 108.23 63.68 81.26 100.92 Transportation - - - - 0.49 5.90 - - 2.63 Other direct costs - - - - - - - - -
Total direct care costs 63.86 81.15 99.09 64.55 79.26 113.23 65.00 83.85 104.70 Indirect agency costs 34.31 56.09 110.89 40.70 57.38 92.49 46.96 73.25 116.23
Total agency cost per visit 108.31 150.96 192.93 107.70 148.93 180.62 124.69 162.14 214.30 Provider-based overhead costs3 18.99 34.89 43.26 21.15 46.73 54.11 25.04 36.24 53.63
Total cost per visit 112.23$ 151.15$ 207.46$ 107.70$ 148.93$ 183.18$ 128.53$ 165.70$ 219.09$ Medical social services
Salaries4 -$ 23.50$ 84.38$ 35.77$ 68.65$ 92.23$ -$ 31.42$ 81.06$ Employee benefits4 - - 12.48 - 8.71 15.86 - - 12.33 Contract services4 - - 65.84 - - 4.09 - - 78.00
Total labor 58.05 83.64 116.53 72.96 88.02 118.05 67.38 86.80 124.00 Transportation - - 5.07 - 2.28 8.15 - - 4.82 Other direct costs - - - - - - - - -
Total direct care costs 59.93 84.50 116.53 78.79 97.02 124.42 70.00 90.00 129.84 Indirect agency costs 57.79 104.00 162.94 50.71 74.37 99.94 59.13 94.78 156.28
Total agency cost per visit 134.56 188.38 266.08 140.27 176.60 227.06 142.57 194.00 275.50 Provider-based overhead costs3 44.71 60.59 90.39 41.43 48.53 53.35 34.51 60.02 99.59
Total cost per visit 139.48$ 188.38$ 266.08$ 146.40$ 190.19$ 228.66$ 144.34$ 197.19$ 285.10$
Health Care Group | www.bkd.com Questions? Contact M. Aaron Little at [email protected].
4 of 7
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
BKD Analysis ofOCS HomeCare Elite,
Top 100
Operating Dashboards (Continued)Cost Per Visit (Continued )Home health aide
Salaries4 12.14$ 18.84$ 26.90$ 15.70$ 21.81$ 28.51$ 13.10$ 19.69$ 27.04$ Employee benefits4 0.46 2.91 4.88 1.62 3.70 5.73 - 2.38 4.31 Contract services4 - - - - - - - - -
Total labor 16.92 23.02 37.04 19.38 28.35 39.31 17.95 24.91 35.36 Transportation - - 4.42 - 3.02 5.45 - - 4.27 Other direct costs - - - - - - - - -
Total direct care costs 20.77 26.60 39.96 24.06 30.24 42.45 20.00 27.47 38.52 Indirect agency costs 14.32 24.09 37.10 16.00 24.15 34.43 16.25 25.57 41.03
Total agency cost per visit 41.34 54.03 68.38 46.18 57.09 76.03 40.91 55.32 77.53 Provider-based overhead costs3 5.40 12.60 16.37 8.72 12.17 30.64 9.91 16.10 24.62
Total cost per visit 41.85$ 55.08$ 70.61$ 46.64$ 59.35$ 76.03$ 41.82$ 56.92$ 80.01$ Overall agency cost per visit (all disciplines) 101.04$ 124.83$ 163.88$ 115.74$ 135.65$ 157.97$ 105.85$ 136.09$ 172.20$ Medical Supplies
Non-routine medical supplies 0.71$ 2.01$ 3.27$ 1.34$ 2.34$ 3.63$ 0.94$ 2.26$ 4.16$ Medicare Episode PaymentsEstimated average case-mix weight2 1.1940 1.3300 1.5395 1.2588 1.3444 1.4722 1.1564 1.3133 1.5193 Average payment ratio2 1.1184 1.2535 1.4527 1.1102 1.1944 1.3817 1.0720 1.2180 1.4200 Medicare episode mix by payment type
Unadjusted episodes 87.1% 90.6% 94.1% 83.7% 86.5% 91.0% 83.7% 88.6% 93.1%LUPA episodes 2.8% 5.1% 9.1% 5.1% 9.5% 12.5% 2.9% 6.5% 11.0%PEP episodes 0.8% 1.6% 2.3% 1.6% 2.3% 3.4% 0.9% 1.8% 3.0%Outlier episodes 0.0% 0.4% 1.8% 0.2% 0.5% 1.3% 0.0% 0.8% 3.1%
Average payment per episode by payment typeUnadjusted episodes 2,458.92$ 2,941.02$ 3,368.09$ 2,788.27$ 3,039.38$ 3,349.99$ 2,481.72$ 2,883.22$ 3,315.64$ LUPA episodes 288.27 321.83 378.67 311.59 347.84 383.64 291.29 328.24 370.90 PEP episodes 868.09 1,011.82 1,508.78 960.55 1,071.28 1,246.43 919.16 1,169.59 1,490.63 Outlier episodes 2,770.30 3,810.96 5,490.54 2,752.89 3,307.33 4,377.80 2,897.57 3,679.16 5,034.59
Health Care Group | www.bkd.com Questions? Contact M. Aaron Little at [email protected].
5 of 7
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
BKD Analysis ofOCS HomeCare Elite,
Top 100
Operating Dashboards (Continued)Medicare Episode ProfitabilityAverage payment per episode 2,328$ 2,648$ 3,148$ 2,501$ 2,708$ 3,141$ 2,285$ 2,670$ 3,115$ Direct costs per episode
Salaries4 554 784 968 687 769 990 512 734 1,003 Employee benefits4 73 116 176 81 125 177 46 97 169 Contract services4 26 148 354 38 104 276 50 219 473
Total labor 869 1,147 1,489 969 1,122 1,344 936 1,170 1,455 Transportation - 33 79 1 47 71 - 15 70 Other direct costs - - - - - - - - - Nonroutine supplies - 9 26 2 18 29 - 8 27
Total direct care costs per episode 919 1,241 1,570 1,025 1,170 1,379 991 1,243 1,536 Direct profit (loss) per episode 1,141 1,365 1,707 1,228 1,507 1,742 1,056 1,409 1,770 Direct profit (loss) margin per episode 45.1% 55.1% 63.8% 48.0% 54.4% 61.8% 44.0% 54.1% 62.3%Indirect agency costs per episode 555 903 1,258 558 814 1,006 727 1,066 1,601
Total agency cost per episode 1,806 2,062 2,435 1,812 2,051 2,396 1,894 2,336 2,914 437 588 833 482 705 928 (22) 337 678
16.1% 23.1% 30.6% 18.3% 25.7% 30.9% -0.9% 12.7% 25.0%Provider-based overhead costs per episode3 387 619 779 384 494 770 499 675 993 Total costs per episode 1,888 2,196 2,573 1,900 2,127 2,501 1,953 2,405 2,984
Overall profit (loss) per episode 266 540 776 384 540 846 (111) 279 637 Profit (loss) margin per episode 9.8% 19.7% 29.0% 16.1% 20.9% 28.3% -4.3% 10.5% 23.3%
Health Care Group | www.bkd.com Questions? Contact M. Aaron Little at [email protected].
6 of 7
Profit (loss) per episode based on total agency costsProfit (loss) margin per episode based on total agency costs
07/17/2013
Medicare Home Health Operations Detail Dashboard ReportPeer Group Data1 State Data1 National Data1
BKD Analysis of All United StatesSHP Benchmark Medicare Certified
Measure Leaders Agencies
Lower Upper Lower Upper Lower UpperQuartile Median Quartile Quartile Median Quartile Quartile Median Quartile
BKD Analysis ofOCS HomeCare Elite,
Top 100
Operating Dashboards (Continued)Gross profit (loss) margin4 35.3% 52.0% 60.8% 34.0% 46.5% 55.3% 39.0% 51.0% 61.0%Agency profit (loss) margin4 1.8% 10.5% 19.2% 4.7% 7.5% 18.4% -3.2% 2.8% 10.8%Salaries as a % of total costs4 50.4% 59.7% 67.6% 52.6% 58.8% 66.9% 47.5% 57.1% 65.0%Salaries as a % of total revenue4 45.9% 50.8% 61.0% 47.7% 53.9% 61.1% 43.9% 54.4% 64.5%Employee benefits as a % of total salaries4 13.5% 18.0% 22.3% 13.5% 18.3% 22.8% 11.0% 15.2% 20.1%
56.0% 70.1% 78.3% 62.6% 72.3% 79.1% 50.8% 65.0% 74.6%47.9% 60.7% 70.8% 55.0% 64.3% 73.9% 46.4% 61.3% 73.4%2.7% 7.8% 14.9% 2.2% 5.2% 12.6% 3.2% 10.3% 21.3%3.3% 6.2% 13.0% 2.1% 4.9% 10.7% 3.1% 10.2% 21.0%
73.5% 81.3% 86.5% 74.2% 80.5% 85.1% 72.3% 79.6% 85.3%61.2% 68.1% 77.3% 63.9% 71.5% 80.8% 64.7% 74.8% 84.3%38.9% 50.8% 60.8% 46.8% 53.1% 62.6% 36.9% 47.5% 58.0%31.1% 41.6% 56.4% 39.9% 47.9% 59.1% 34.6% 44.6% 55.3%19.2% 27.7% 35.7% 16.4% 24.4% 33.3% 19.3% 27.8% 38.7%17.6% 25.9% 29.9% 14.6% 21.0% 29.8% 17.6% 26.8% 39.5%0.2% 2.3% 4.4% 1.8% 3.1% 4.1% 0.0% 1.9% 3.8%0.1% 2.1% 3.8% 1.6% 2.9% 3.6% 0.0% 1.5% 3.4%
10.4% 15.9% 25.0% 12.2% 15.2% 22.2% 12.2% 18.3% 26.0%10.5% 17.2% 24.5% 10.4% 15.5% 20.7% 12.9% 18.9% 27.1%29.5% 39.0% 47.7% 29.1% 37.6% 44.5% 30.7% 39.8% 48.7%31.6% 36.0% 42.0% 26.2% 34.7% 41.4% 29.5% 39.2% 48.9%
Capital & plant costs as a % of total cost4 2.0% 2.8% 4.2% 2.4% 2.9% 4.1% 2.4% 3.5% 5.1%Capital & plant costs as a % of total revenue4 1.8% 2.8% 4.1% 2.1% 2.7% 3.8% 2.3% 3.4% 5.2%Days in accounts receivable4 36.5 52.3 78.1 41.4 53.1 75.7 38.1 53.5 77.6 Current ratio4 1.4 3.4 8.3 1.1 2.4 4.9 0.9 1.8 4.9 Quick ratio4 1.0 3.0 5.5 1.0 1.9 3.5 0.8 1.5 3.9 Return on equity4 8.2% 28.8% 76.4% 3.6% 19.9% 45.9% -6.1% 13.9% 77.1%Return on assets4 2.4% 28.6% 87.5% 6.4% 16.6% 50.5% -9.5% 8.7% 51.9%
1Data compiled using all Medicare cost reports available from CMS with fiscal years ending in 2011.2Estimated based on payment rates effective for the location of the agency rather than service area.3Dashboard indicator only applies to hospital-based agencies, and accounts for costs allocated to the agency from the provider.4Dashboard indicator only includes freestanding agencies as hospital-based agency data is not available from CMS data sets.5Estimated based on 230 work days per year.
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Total labor as a % of total revenue4
Direct labor as a % of total costs4
Direct labor as a % of total revenue4
Indirect labor as a % of total costs4
Total salaries & employee benefits as a % of total costs4
Total salaries & employee benefits as a % of total revenue4
Purchased services as a % of total costs4
Administrative & general costs as a % of total revenue4
Indirect labor as a % of total revenue4
Transportation as a % of total costsTransportation as a % of total revenue4
Other costs as a % of total costsOther costs as a % of total revenue4
Administrative & general costs as a % of total cost
Purchased services as a % of total revenue4
Total labor as a % of total costs
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
1
NAHC Financial Management Conference & Exposition
July 28, 2013
855A Requirements & Revalidation
Presented by: Thomas E. Boyd, Principal Boyd & Nicholas, Inc.
• New Location• New Business Name/add LLC or Inc.• Change in ownership• Acquisition/merger or stock transfer• Additional Branch office
Requirements for Filing
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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Individual Updates/Changes
• If they have a 5 percent or greater direct or indirect ownership interest in the provider
• If (and only if) the provider is a corporation(whether for-profit or non-profit), all officersand directors of the provider
Individual Updates/Changes
• All managing employees of the provider• All individuals with a partnership interest in
the provider, regardless of the percentage of ownership the partner has
• Authorized and delegated officials
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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Timeline for Submission
√ Change of ownership√ Acquisition/Merger√ Asset Sale√ Stock Transfer
Timeline for Submission
√ Updates to the provider – ie: change of information
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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Revalidation Project
• If you enrolled in the Medicare Program before March 25, 2011 you will get a letter by March of 2015.
Revalidation Project
• DO NOT respond until you get your letter.
• You have 60 days from the date of your letter (not two months) to submit your 855A revalidation.
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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• Be watching for your letter. Many are not addressed to a specific person.
Revalidation Project
Revalidation Project
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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Revalidation Project
You must submit a paid receipt with your revalidation letter and 855A
https://pecos.cms.hhs.gov/pecos/FeePaymentWelcome.do
Revalidation Project
• MACs are requesting your NPI email assigning your NPI – most went out in 2006. If you don’t have a copy of the email:
• Contact NPPES customer service at 800-465-3203 OR if you remember your user ID and password go to website and login, check that info is current and proceed to end and submit.
• You will get a new email in 24-36 hours.
https://nppes.cms.hhs.gov/NPPES/Welcome.do
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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Revalidation Project
We recommend at this time NOT to submit your 855As or Revalidation 855As in PECOS. There are many bugs in the PECOS system causing hardship to providers and delaying the submission. Instead complete the CMS downloaded pdf form:
https://www.cms.gov/cmsforms/downloads/cms855a.pdf
This form was updated in July 2011. Make sure you are using the correct form as above.
Who Has Questions ???
Pre-Conference 2701. Home Health Summer Camp 2013Reporting Medicare Organizational Changes
July 28, 2013
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Contact Information
Tom Boyd, MBA, CFEPrincipalBoyd & Nicholas, [email protected]
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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2013 Financial Management Conference
Home Health Summer Camp 2013
William J. Simione, IIIPrincipal Simione Healthcare Consultants, LLC
Value Driven Health Care Environment
What do we know & what do we need to know
1. Do we truly understand our costs & how they relate to patient care?
2
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
2
Value Driven Health Care Environment
A. Do we truly understand our cost and how they relate to patient care?① What do I need to get myself ready?
Do I have the data? Do I understand the data? Do I know how to react to the data?
② Understanding the Gross Margin Direct Salaries & Benefits Contracted Services Transportation Medical Supplies Other Direct Care Costs
3
Value Driven Health Care Environment
B. Do we truly understand our cost and how they relate to patient care?③ Payer Analysis
GM Profitability Net Margin Profitability
④ Can we measure the true value of our services? Difficult many times to truly qualify the value of Home
Health Need to demonstrate that we are operating efficiently Need to have the seat at the table to educate all parties All indicators need to be positive Know the “Pain Points” of our referral sources
“Home Care is not an adjunct service, but a key component in the health care continuum”
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
3
INTEGRATING CLINICAL &
FINANCIAL MANAGEMENT
Integrating Clinical & Financial Management
• The need for both clinical and financial information is becoming more important to home care agencies.→Recognize key clinical and financial indicators
that can be used daily, weekly, etc.→Analyze trends by comparing to previously run
data.→Use data to integrate and educate your clinical
and financial teams; and→Report to senior managers and Board of
Directors
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
4
Key Financial Indicators
• Gross Margin• Net Margin• Payer Mix• Liquidity Ratios• Cost Per Visit• Days Sales
Outstanding
• Case Weight Mix• Episode Distribution• Reimbursement per
Episode• Cost Per Episode• Indirect Cost as a
Percentage of Revenue
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Integrating Clinical & Financial Management
How does this relate back to Clinical?
How do I share this data?
Where do I begin?
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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STEP #1
Dive Into The Data
• Maximize your EMR system?• Do we truly understand all of the reports?• What reports are the Clinical
Director/Supervisors currently using?Are they meeting their needs?What information could they use?
• Can we do a data Dump? Is this the only way?
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Dive Into The Data
• Understand your businessWhat makes up your revenue?How are we providing services?Does the data tell/confirm the story?
Do we truly understand what is happening?
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Dive Into The Data - Episodic Payers
• Can we determine the following?# of Episodes per admission
• Can we determine outliers?– Try and understand the reasons
# of visits per Episode by type of Episode• How/Does this change for subsequent episodes?• How/Does this change by diagnosis?• Duals vs. Regular admissions
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Life Of An AdmissionColumn LabelsCount of SOC/Re-Cert
Row Labels 1 2 3 4 5 6 7January-12 72 30 10 3February-12 60 25 5 2March-12 55 17 9 6 4 2 2April-12 73 29 8 2May-12 72 22 6 1June-12 78 25 7 1July-12 57 17 3August-12 72 12 1 1September-12 70 17 4 1October-12 69 15 1November-12 58 14 3 1December-12 51 13January-13 40 4February-13 43 2March-13 24April-13 7Grand Total 901 242 57 18 4 2 2
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Life of an Admission - Visits Per EpisodeCarrier Medicare/OHActive/D/C D/C5/1/2013 (All)
Average of Tot Visits Column LabelRow Labels 1 2 3 4 5 6 7 Grand TotalJanuary-12 25.31 22.27 15.90 14.67 23.42 February-12 24.18 17.92 14.80 5.50 21.57 March-12 23.98 21.00 21.44 17.83 14.00 21.50 13.50 22.13 April-12 21.10 15.90 12.50 9.50 18.93 May-12 20.06 14.00 16.67 1.00 18.35 June-12 22.05 16.24 16.14 10.00 20.26 July-12 18.53 14.06 7.33 17.10 August-12 16.97 14.50 30.00 20.00 16.81 September-12 19.67 19.53 18.25 3.00 19.40 October-12 20.16 11.87 4.00 18.51 November-12 17.47 20.36 20.67 1.00 17.91 December-12 19.02 11.15 17.42 Grand Total 20.74 16.95 16.32 12.00 14.00 21.50 13.50 19.53
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Life of an Admission - Therapy VisitsCarrier Medicare/OHActive/D/C D/C5/1/2013 (All)
Average of Tot Ther Column LabelRow Labels 1 2 3 4 5 6 7 Grand TotalJanuary-12 11.72 8.70 2.50 5.33 9.97 February-12 11.50 3.92 - - 8.57 March-12 10.11 8.76 5.78 6.17 1.00 - 0.50 8.41 April-12 8.88 3.66 1.38 4.00 6.90 May-12 8.36 4.68 4.17 - 7.23 June-12 9.13 2.80 1.00 - 7.11 July-12 7.47 3.47 - 6.30 August-12 7.00 3.67 20.00 11.00 6.73 September-12 7.81 2.59 2.00 - 6.51 October-12 8.83 2.20 - 7.55 November-12 7.28 3.50 - - 6.20 December-12 8.61 2.00 7.27 Grand Total 8.89 4.42 2.60 4.00 1.00 - 0.50 7.47
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Life of an Admission (cont’d)
Carrier Medicare/OHActive/D/C D/C5/1/2013 (All)
Column LabelAverage of RAP_HHRG$
Row Labels 1 2 3 4 5 6 7January-12 2,559.62$ 2,903.91$ 2,064.69$ 1,500.42$ February-12 2,646.29$ 2,402.44$ 1,762.56$ 2,381.42$ March-12 2,374.75$ 2,865.41$ 2,567.85$ 2,828.32$ 2,049.48$ 2,212.65$ 1,928.71$ April-12 2,666.44$ 2,235.19$ 1,819.60$ 1,968.26$ May-12 2,539.27$ 2,578.12$ 2,651.51$ 2,191.38$ June-12 2,646.97$ 2,407.64$ 2,135.56$ 1,519.37$ July-12 2,537.08$ 2,354.05$ 1,922.95$ August-12 2,500.09$ 2,243.65$ 1,382.59$ 5,021.68$ September-12 2,642.28$ 2,173.58$ 1,995.42$ 1,930.76$ October-12 2,749.82$ 2,127.41$ 2,246.49$ November-12 2,715.61$ 2,492.54$ 1,959.17$ December-12 2,674.99$ 2,354.92$ Grand Total 2,606.21$ 2,453.11$ 2,127.06$ 2,401.98$ 2,049.48$ 2,212.65$ 1,928.71$
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Life of an Admission (cont’d)
Carrier Medicare/OHActive/D/C D/C5/1/2013 (All)
Average of Final$ Column LabelRow Labels 1 2 3 4 5 6 7 Grand TotalJanuary-12 3,519.29$ 2,946.86$ 1,740.26$ 2,052.73$ 3,174.00$ February-12 3,469.40$ 2,208.85$ 1,466.77$ 1,546.77$ 2,976.23$ March-12 3,280.92$ 3,096.30$ 2,606.69$ 2,200.32$ 2,054.67$ 2,324.32$ 2,112.23$ 3,033.96$ April-12 3,074.99$ 2,216.64$ 1,774.89$ 1,639.72$ 2,731.17$ May-12 2,888.30$ 2,426.47$ 2,290.80$ 107.92$ 2,724.68$ June-12 3,192.65$ 2,196.92$ 2,129.69$ 1,527.34$ 2,886.35$ July-12 2,780.47$ 2,226.55$ 1,444.45$ 2,606.12$ August-12 2,756.39$ 2,119.28$ 3,055.33$ 2,669.96$ September-12 2,811.06$ 2,278.84$ 2,151.45$ 439.73$ 2,663.83$ October-12 3,037.20$ 2,028.13$ 439.73$ 2,838.10$ November-12 2,582.81$ 2,516.43$ 1,745.18$ 2,561.40$ December-12 2,908.78$ 1,567.54$ 2,724.69$ Grand Total 3,031.03$ 2,378.97$ 1,962.66$ 1,815.49$ 2,054.67$ 2,324.32$ 2,112.23$ 2,818.32$
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Dive into the Data - Other Payers
• Look at the visit volumeDo we know visits per admissionDoes this differ by Payer
• Can we drill down to the diagnosis?• What is the trend?
Medicaid volume• Duals• Traditional• Move to Managed – What does this mean?
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
10
Dive into the Data - Other Payers
• What is our censusNeed to know by payer
• Do we have patients with no visits within the last 30 days?
• Are we tracking admission by payer, by month, by referral source?Grow Market Share through strategic
alliancesIs there a trend? How should we react?
19
Dive into the Data - Episodic Payers
• Meet with staff to understand what is happeningWhat is the storyIs it helpful
• Why is this important to understand the dataFinancialClinical
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
11
STEP #2
Staffing
• Understand how admissions and Episodes equate to staffingDirectIndirect
• Develop Productivity expectations throughout the organizationProductivity should be consistent and
measurable
22
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
12
Methodology Options - Weighted Calculation
• Weight types of visits based on length of visits and documentation timeSOCResumptionsRecertificationsDischargeHigh mileageHigh tech/high skill
• Weighted visits not consistent in the industry -difficult to compare
23
Methodology Options - Direct Calculation
# Visits/Day# visits in a given time
# FTE’s x # Days
24
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Methodology Options - Direct Calculation
# of visits# FTE’s x # Days # Visits/Day
• Number of visits In a given time (week, month)By individualBy discipline (RN include LPN, PT include PTA)By team
• Number of FTE’sSum of full time equivalents NOT employees
• Number of days available to workAfter benefit and meeting time
25
Number of Days Available to Work - Example
• In order to meet national productivity benchmarks, staff must have at least 80 - 85% of their time available to visit.
Example Hours Days %
Payroll Time Paid Time Off
2,080 240
260 30
100% 11.5%
Time Available to work 1,840 230 88% Mandatory In-Service/Education Required Staff Meetings
12 72
1.5 9
0.5% 3.5%
Total Time Available to Visit 1,756 219.5 84%
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Productivity Forces• MotivationEconomicCareer developmentManagement practices
• Impact of culture, conflicts and trust
• EfficiencyEffective toolsSkills developmentEducation and training
• UtilityMeasure of satisfaction or impact the work
27
Factors Impacting Productivity
• Average miles per visit• Time available to visit• Agency Patient-Related Characteristics Casper
Report• Prior conditions• Hospitalization risks• Needs help with ADL’s/IADL’s but none is available• Stage IV pressure ulcers• Significant differences in
– Acute Conditions– Chronic Conditions– Home Care Diagnosis
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
15
Staff Collaboration
• Setting expectations• Historical performance• Performance reports and feedback• Team productivityTeam building activitiesTrust and collaborationSuccess of the unit vs. success of the individual
29
BALANCING ACT
Patient Expectations
Patient Needs
Optimal Outcomes
Productivity Expectations
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Financial & Clinical Reporting
• How do I compare my metrics?Internal Data
• Trending• Locations• Teams• Providers
External Data• Benchmarks
– National– Regional – State– Agency Attributes
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Financial & Clinical Reporting
• How can I measure my performance?Key IndicatorsDashboardsBenchmarks
• What performance indicators should I use?Agency must evaluate what is important
• Revenue Drivers• Cost Drivers• Quality Drivers
• How often should I be reporting my performance?
32
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
17
Financial Reporting
• Internal DataTrack through dashboard for each locationTrending data (weekly, monthly, quarterly)Financial Statements
• Operating Revenue• Operating Expenses• General and Administrative Expenses
Gross Margin• Operating Revenue minus Operating Expenses• Operating Margin
33
Example of Dashboard
YTD Budgeted YTD
2/28/13 Budget Variance 1/31/13 12/31/12 11/30/12 10/31/12 9/30/12 8/30/12 Totals Totals
Admissions Home Health 1
Medicare 139 145 (6) 139 130 139 143 137 135 962 1,015 Medicaid 50 40 10 50 50 50 50 50 50 350 280 Blue Cross 25 20 5 25 25 25 25 25 25 175 140 Private Insurance 35 40 (5) 35 35 35 35 35 35 245 280 Other 15 10 5 15 15 15 15 15 15 105 70
Grand Total 264 255 9 264 255 264 268 262 260 1,837 1,785
Visits Home Health 1
Medicare 2,453 2,559 (106) 2,453 2,295 2,453 2,524 2,418 2,383 16,979 17,915 Medicaid 750 600 150 750 750 750 750 750 750 5,250 4,200 Blue Cross 200 160 40 200 200 200 200 200 200 1,400 1,120 Private Insurance 280 320 (40) 280 280 280 280 280 280 1,960 2,240 Other 120 80 40 120 120 120 120 120 120 840 560
Grand Total 3,803 3,719 84 3,803 3,645 3,803 3,874 3,768 3,733 26,429 26,035
Monthly Admissions Report for Billing Date: Thursday, February 28, 2013
ADMISSIONS AND DISCHARGESLast 5 Months
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
18
Example of Dashboard
Year to Date
2/28/13 1/31/13 12/31/12 11/30/12 10/31/12 9/30/12 8/30/12 Totals
Episodes
Beginning 166 154 171 162 161 161 180 1,155 Ending 150 152 166 152 170 163 158 1,111
Average Visits Per Episode 2/28/13 Budget Variance YTD Average
Budgeted
YTD
Skilled Nursing 7.20 7.00 0.20 6.30 6.80 6.80 7.20 6.40 6.50 6.74 7.00 Physicakl Therapy 4.90 5.00 (0.10) 5.20 5.10 5.70 5.20 4.70 5.10 5.13 5.00 Occupational Therapy 0.70 0.75 (0.05) 0.70 0.70 0.90 0.90 0.80 0.50 0.74 0.75 Speech Therapy 0.20 0.15 0.05 0.20 0.20 0.10 0.10 0.30 0.10 0.17 0.15 Medical Social Service 0.10 0.10 - 0.10 0.10 0.10 0.10 0.10 0.10 0.10 0.10 Home Health Aide 1.90 1.50 0.40 1.80 1.10 1.90 1.60 1.70 1.50 1.64 1.50
Grand Total 15.00 14.50 0.50 14.30 14.00 15.50 15.10 14.00 13.80 14.53 14.50
Episodes Ending YTD Average
LUPA 20 18 20 18 21 22 32 22 PEP 2 2 2 2 3 1 3 2 Outlier 2 - - - - 1 1 1 Therapy Downcode 33 48 51 34 44 33 39 40 Therapy Upcode 46 38 43 39 50 52 39 44 Unadjusted 47 46 50 59 52 54 44 50
Grand Total 150 152 166 152 170 163 158 159
Case Mix 2/28/13 Budget Variance YTD Average Budgeted
1.2000 1.1900 0.0100 1.1800 1.1900 1.3200 1.2500 1.3300 1.1844 1.2363 1.2000
PPS SUMMARYLast 5 Months
35
Example of Dashboard
Budgeted
2/28/13 Budget Variance 1/31/13 12/31/12 11/30/12 10/31/12 9/30/12 8/30/12 YTD
Revenue
Medicare 425,788 425,788 - 425,788 425,788 425,788 425,788 425,788 425,788 11Medicaid 63,750 51,000 12,750 63,750 63,750 63,750 63,750 63,750 63,750 11Blue Cross 2,625 2,100 525 2,625 2,625 2,625 2,625 2,625 2,625 10Private Insurance 4,375 5,000 (625) 4,375 4,375 4,375 4,375 4,375 4,375 1Other 1,500 1,000 500 1,500 1,500 1,500 1,500 1,500 1,500 0
Total Revenue 498,038$ 6$ 498,032$ 498,038$ 498,038$ 498,038$ 498,038$ 498,038$ 498,038$ 35
Gross Margin
Home Health 1 42.00% 43.00% -1.00% 43.00% 42.00% 40.00% 45.00% 45.00% 40.00% 42.43% 43.00%
Net Margin
Home Health 1 10.00% 10.00% 0.00% 8.00% 9.00% 9.00% 10.00% 10.00% 10.00% 9.43% 10.00%
Last 5 Months
Financial Summary
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
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Example of Dashboard
DSO
Medicare 54 49 5 54 54 54 54 54 54 Medicaid 68 64 4 68 68 68 68 68 68 Blue Cross 70 66 4 70 70 70 70 70 70 Private Insurance 75 58 17 75 75 75 75 75 75 Other 75 58 17 75 75 75 75 75 75
Total DSO 65 55 10 65 65 65 65 65 65
Claims YTD Total YTD BudgetDay to RAP 8 6 2 6 6 6 6 6 6 6 6 Days to Final 15 15 - 14 18 17 14 15 16 16 15
Orders
Days Orders Outstanding 20 20 - 20 22 25 21 21 21 21 20 Days F2F Outstanding 25 25 - 22 24 23 20 21 25 23 25
Financial Summary
37
Example of Dashboard
YTD Budgeted
2/28/13 Budget Variance 1/31/13 12/31/12 11/30/12 10/31/12 9/30/12 8/30/12 Totals YTD
Skilled Nursing 4.50 5.00 (0.50) 4.50 4.50 4.50 4.50 4.50 4.50 4.50 5.00 Physical Therapy 5.25 5.00 0.25 5.00 5.00 5.00 5.00 5.00 5.00 5.04 5.00 Occupational Therapy 5.00 5.00 - 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 Speech Therapy 5.00 5.00 - 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 Medical Social Service 4.00 4.00 - 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 Home Health Aide 3.00 4.00 (1.00) 3.00 3.00 3.00 3.00 3.00 3.00 3.00 4.00
Clinical ProductivityLast 5 Months
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Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
20
Financial & Clinical Reporting
• External Benchmark DataCompare to changes in industry
• Reimbursement changes• State legislative changes• Clinical performance measures
Monitor performance and goals• Use benchmarks as goals• Evaluate management and staff performance on
constant basis• Evaluate whether weakness is an internal issue or
industry issue• Ability to make better business decisions
39
Financial Reporting
• Break out Direct Cost vs. Indirect CostsDirect - Patient CostsIndirect - Support Costs
• Gross MarginOperating Revenue minus Operating ExpensesOperating Margin
• Net MarginOperating Revenue minus Direct Expenses and
General and Administrative Expenses
40
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
21
Things To Consider
• Revenue Rate per Episode, Visit, Hour or Day is lower than
what you budgeted Shift in utilization of services Home Health Aide vs. Nursing Visits Payer Shift Per Visit vs. Per Episode Lower Rates
• Anticipated increases in volume did not occur
41
Things To Consider
• Productivity not in line with budget• Staffing Capacity - Over/Under Staffed• Transportation/Mileage Expense
Eliminate paying from Home to First VisitRate
• Medical SuppliesCloset vs. Drop Ship
• Service UtilizationFrequency of visitsTypes of visits per Episode
• Schedule Based on Location of Patient42
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
22
Things To Consider
• Hiring restrictions based on CaseloadRN Case Managers - 25 to 30 CasesOne Team Per 350-375 Patients 10 -15 RN Case Managers Per TeamOne Clinical Supervisor Per TeamOne Clinical Assistant Per Team
• Increase CompetitionLoss of Market ShareMergers/AcquisitionsReferral Sources getting into Home Care and Hospice
43
Things To Consider
• SEMI-VARIABLE EXPENSES
• Staff Home Care Coordinators/Liaison Nurse Intake Nurse Billing/Collectors Clinical Supervisor Clinical Assistant Insurance Case Manage Administrative Assistants
• Develop and Monitor Staffing Ratios
• Develop and monitor Key Performance Indicators
44
Pre-Conference 2701. Home Health Summer Camp 2013Compliance in Organizational Change
July 28, 2013
23
PROPERTY OF SIMIONE HEALTHCARE CONSULTANTS45
SIMIONE.COM
Simione™ Healthcare Consultants provides solutions for your core homecare and hospice challenges – organizational, financial, sales & marketing,technology, and mergers & acquisitions. Over 1000 organizations use ourpractical insight and tools to reduce costs, mitigate risk and improveefficiencies to steward the way they conduct business.
William J. Simione, III4130 Whitney AvenueHamden, CT 06518
203.287.9288800.949.0388
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
1
2013 Financial Management Conference
Home Health Summer Camp 2013
William J. Simione, IIIPrincipal Simione Healthcare Consultants, LLC
UNDERSTAND YOUR MARKET
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
2
Elements of a Feasibility Study
A. Understand your market① ACO Developments Who is forming ACO’s in your Market
Health Systems / Hospitals Physicians
Are we in a position organizationally and financially to accept risk and/or integrate with these organizations?
② Alignment of care Mergers and Acquisitions Activity
Health Systems / Hospitals Physician Practices Long Term Care (SNF, ALF, ILF) Home Health Etc.
3
Elements of a Feasibility Study
A. Understand your market③ Population Health Management④ Who’s entering into risk share contracts Medicaid Dually Eligible Bundling
⑤ Health Transitions
4
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
3
Elements of a Feasibility Study
A. Understand your market - What questions do we need to answer?
1. Who will be our key Partners?2. How do we get a seat at the table?
“C” Suite to “C” Suite3. What will be our value proposition?
What value can we provide to our partner? How will we solve our partner’s problems?
What is important? What is your Strategy?
4. How do we get and keep our partners? Customer Relations
5. Revenue Stream What value are our partner’s willing to pay
5
DEVELOP THE FEASIBILITY STUDY
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
4
Understand Revenue
• Know the measurable indicators that build RevenueHome Health
• Episodes Per Month• Visits - FFS
Hospice• Days by Level of Care
Private Duty• Hours
7
Understand Revenue
• Know what Indicators drive revenueHome Health
• Episodes Per Month– Admissions– Re-Certifications
• Types of Episodes– Full– LUPA– Outliers
• Visits Per Episode– By Type of Episode
Other Payers• Visits by Discipline• Revenue by Discipline
8
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
5
How to Develop - Revenue
• Each indicator should be automatedEasy to useEasy to obtainReliable
• Information Technology and Finance should Partner to ensure Success
• Resources need to be available • All Indicators need to have an audit trail• Who will be responsible to:
GenerateSummarize
• What will be the timing of the reports
9
How to Develop - Net Income
• Can the budget be built by team or location• Make sure everyone’s aware of their expectations• MOST IMPORTANT
MAKE SURE YOU HAVE BUY IN
• Revenue should be the driver of all ExpensesDirectIndirect
10
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
6
How to Develop - Revenue
• Know your Information SystemStandard ReportsCustomOutside Package
11
Medicare Episodes
• Total Episodes 1,653• Recertification Rate 21% 347• Admissions 79% 1,306
Increase /
Regular LUPA Outlier Total Based Decrease by Total Regular LUPA OutlierMonth # Days 86.23% 13.77% 0.00% Episodes Episodes Episodes 86.23% 13.77% 0.00%
January 31 108 17 - 125 136 - 136 117 19 - February 30 102 16 - 118 136 - 136 117 19 - March 31 106 17 - 123 136 - 136 117 19 - April 31 108 17 - 125 136 1 137 118 19 - May 28 113 18 - 131 136 1 137 118 19 - June 31 113 18 - 131 136 1 137 118 19 - July 30 119 19 - 138 136 2 138 119 19 - August 31 122 20 - 142 136 2 138 119 19 - September 30 116 19 - 135 136 2 138 119 19 - October 31 116 19 - 135 136 4 140 121 19 - November 31 119 19 - 138 136 4 140 121 19 - December 30 117 19 - 136 136 4 140 121 19 - Total 365 1,360 217 - 1,577 1,632 21 1,653 1,425 228 -
4.82%
Medicare PPS StatisticsMedicare Episodes
Projected FY 2012 EpisodesCurrent Year FY 2011 Annualized Episodes
12
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
7
Medicare Visits Per Episode
• Important to know where you are today• Make your assumptions realistic
Budgeted Actaul FY 11 Current Targeted Actaul FY 11 Current Targeted Actaul FY 11
DisciplineAnnual Visits
Visits Per Episode
Visits Per Episode
Visits Per Episode
Visits Per Episode
Visits Per Episode
Visits Per Episode
Visits Per Episode
Visits Per Episode
SN 13,028 9.14 9.14 501 2.20 2.16 - - - PT 5,431 3.81 3.81 75 0.33 0.33 - - - OT 1,596 1.12 1.12 9 0.04 0.04 - - - ST 71 0.05 0.05 - - - - - - MSW 442 0.31 0.31 5 0.02 0.02 - - - HHA 2,894 2.03 2.03 7 0.03 0.20 - - -
Total 23,462 16.46 16.46 596 2.62 2.75 - - -
Regular LUPA Outliers
Medicare Visits
13
Medicare Visits
Discipline
Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Medical Social
ServicesHome Health
Aide Total VisitsSkilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Medical Social
ServicesHome Health
Aide Total Visits
January 1,072 447 131 6 36 238 1,930 41 6 1 - 0 1 49 February 1,072 447 131 6 36 238 1,930 41 6 1 - 0 1 49 March 1,072 447 131 6 36 238 1,930 41 6 1 - 0 1 49 April 1,080 450 132 6 37 240 1,945 42 6 1 - 0 1 49 May 1,080 450 132 6 37 240 1,945 42 6 1 - 0 1 49 June 1,080 450 132 6 37 240 1,945 42 6 1 - 0 1 49 July 1,088 453 133 6 37 242 1,959 42 6 1 - 0 1 50 August 1,088 453 133 6 37 242 1,959 42 6 1 - 0 1 50 September 1,088 453 133 6 37 242 1,959 42 6 1 - 0 1 50 October 1,103 460 135 6 37 245 1,987 42 6 1 - 0 1 51 November 1,103 460 135 6 37 245 1,987 42 6 1 - 0 1 51 December 1,103 460 135 6 37 245 1,987 42 6 1 - 0 1 51 Total 13,028 5,431 1,596 71 442 2,894 23,462 501 75 9 - 5 7 596
July
Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Medical Social
ServicesHome Health
Aide Total Visits
January 1,113 453 132 6 37 239 1,979 February 1,113 453 132 6 37 239 1,979 March 1,113 453 132 6 37 239 1,979 April 1,121 456 133 6 37 240 1,994 May 1,121 456 133 6 37 240 1,994 June 1,121 456 133 6 37 240 1,994 July 1,129 460 134 6 37 242 2,008 August 1,129 460 134 6 37 242 2,008 September 1,129 460 134 6 37 242 2,008 October 1,146 466 136 6 38 246 2,038 November 1,146 466 136 6 38 246 2,038 December 1,146 466 136 6 38 246 2,038 Total 13,529 5,506 1,606 71 446 2,900 24,058
LUPA EpisodesFull Episodes
Total Visits
14
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
8
Medicare Revenue
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12CBSA Code
CY 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 Budget 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800 1.2800
CBSA CODE
CBSA Code SN PT OT ST MSW HHA
Localized National Rate 2,514.85$ 132.74$ 145.15$ 146.13$ 157.72$ 212.81$ 60.13$ Targeted Rate 3,219.01$ Avg. per Day Unadjusted for CM 41.91$
Method 60 days
Revenue Recognition:
Medicare Case Mix Weight
All episodes will be assumed to begin on the 15th of the month.
15
Medicare Revenue
• Revenue CalculationMedicare Episodes 138 (Daily Rate x Case Mix)X Episodic Base Rate Daily 53.65 ($41.91 x 1.2800)X Total Days in the Month 16= Medicare Revenue $118,460
# Episodes Case Mix
Beginning Weight Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12Nov-11 138 1.2800 118,460 229,516 96,248 - - - - - Dec-11 136 1.2800 - 124,039 226,189 87,557 - - - - Jan-12 136 1.2800 - - 124,039 211,596 102,150 - - - Feb-12 136 1.2800 - - - 109,446 226,189 102,150 - - Mar-12 136 1.2800 - - - - 124,039 218,893 94,854 - Apr-12 137 1.2800 - - - - - 117,601 227,852 95,551 May-12 137 1.2800 - - - - - - 124,951 220,502 Jun-12 137 1.2800 - - - - - - - 117,601 Jul-12 138 1.2800 - - - - - - - - Aug-12 138 1.2800 - - - - - - - - Sep-12 138 1.2800 - - - - - - - - Oct-12 140 1.2800 - - - - - - - - Nov-12 140 1.2800 - - - - - - - - Dec-12 140 1.2800 - - - - - - - - Jan-13Feb-13
Total 446,477 408,600 452,378 438,644 447,657 433,655
Epi
sode
Sta
rt D
ate
(15t
h of
mon
th)
Full Medicare EpisodesRevenue Recgonized in Period
16
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
9
Medicaid Revenue
31 31 30 31 30 312011 Actual Visits Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12
Skilled Nursing 70.53% 406 406 406 406 406 406 Physical Therapy 18.98% 109 109 109 109 109 109 Occupational Therapy 4.10% 24 24 24 24 24 24 Speech Therapy 0.20% 1 1 1 1 1 1 Medical Social Service 0.00% - - - - - - Home Health Aide 6.18% 36 36 36 36 36 36
100.00% 576 576 576 576 576 576
2012 Budgeted Visits
Budgeted Increase Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12
Skilled Nursing 0.00% 426 426 426 426 426 426 Physical Therapy 0.00% 115 115 115 115 115 115 Occupational Therapy 0.00% 25 25 25 25 25 25 Speech Therapy 0.00% 1 1 1 1 1 1 Medical Social Service 0.00% - - - - - - Home Health Aide 0.00% 37 37 37 37 37 37 Total Visits 604 604 604 604 604 604
Current Trend
Budgeted Increase
Total Monthly Visits
Mnthly Avg 576 5% 604
Medicaid Visits & Revenue
17
Medicaid Revenue
2012 Budgeted Visits
Adjustments to
Distribution Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12Skilled Nursing 0.00% 426 426 426 426 426 426 Physical Therapy 0.00% 115 115 115 115 115 115 Occupational Therapy 0.00% 25 25 25 25 25 25 Speech Therapy 0.00% 1 1 1 1 1 1 Medical Social Service 0.00% - - - - - - Home Health Aide 0.00% 37 37 37 37 37 37 Total Visits 604 604 604 604 604 604
Revenue
Net Skilled Nursing 86.99$ 37,076$ 37,076$ 37,076$ 37,076$ 37,076$ 37,076$ Physical Therapy 68.30$ 7,835 7,835 7,835 7,835 7,835 7,835 Occupational Therapy 71.20$ 1,763 1,763 1,763 1,763 1,763 1,763 Speech Therapy 72.88$ 89 89 89 89 89 89 Medical Social Service -$ - - - - - - Home Health Aide 25.38$ 948 948 948 948 948 948
Net Medicaid Revenue 47,712$ 47,712$ 47,712$ 47,712$ 47,712$ 47,712$
Medicaid Visits & Revenue
18
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
10
SN Staffing Requirements
Normal Work Week Paid Time Off (PTO) Days % Productivity SN Visit SN AdmitNumber of hours worked per year 2,080 Sick Days 20 Hours per Visit - - Number of hours in work week 40.00 Vacation Days 20 Visits per Day 5.00 Number of hours worked per day 8.00 Admin 6 Miles per Visit 7.00 Number of days worked per week 5.00 Holidays 5 Admin Time per Day (hours) - Full Time Hourly Staff - Overtime Rate 2.50% Total PTO Days 51 20% Admin Time per Days (hours) - Per Visit Staff -
Estimated PTO %
19
SN Staffing Requirements
• Productivity Calculation Days Available to Work 22 Daily Productivity 5 Gross Productivity 110 PTO % 80% Productivity Net 88
Year Expectations Gross1,310 Year Expectations Net 1,053
Total Days Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12Total Days in Month 31 29 31 30 31 30
Non-Work Days 9 8 9 9 8 9 Workdays 22 21 22 21 23 21
FTE Hours per Month 176 168 176 168 184 168
Total Visits Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12
Grand Total Visits 2,771 2,771 2,771 2,793 2,793 2,793
Productivity Expectations - Gross 110 105 110 105 115 105 Productivity Expectations - Net 88 84 88 84 92 84
20
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
11
SN Staffing Requirements
• FTE Calculation Visits 2,771 Visits Per FTE 88 Needed FTE’s 31.33
Skilled Nursing Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12Visits - by Location
Full Time StaffLocation #1 1,801 1,801 1,801 1,815 1,815 1,815 Location #2 970 970 970 977 977 977
2,771 2,771 2,771 2,793 2,793 2,793
Full Time Staff Needed- By LocationFull Time Staff
Location #1 20.37 21.34 20.37 21.51 19.64 21.51 Location #2 10.97 11.49 10.97 11.58 10.57 11.58
31.33 32.82 31.33 33.09 30.21 33.09
Full Time Staff FTEs - By LocationFull Time StaffLocation #1 15.27 15.27 15.27 15.27 15.27 15.27 Location #2 8.22 8.22 8.22 8.22 8.22 8.22
23.50 23.50 23.50 23.50 23.50 23.50
21
SN Staffing Requirements
• Per Diem Calculation FTE’s Required 31.33 Current FTE’s 23.50 Per Diem Need 7.83 Visits Per FTE 88 Per Diem Visits 693
Per Diem Staff Visits - By LocationFull Time Staff
Location #1 450 512 450 526 403 526 Location #2 242 275 242 283 217 283
693 787 693 809 620 809
Skilled Nursing Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12Per Diem Rate 55.00$
Full Time StaffLocation #1 24,762 28,138 24,762 28,934 22,181 28,934 Location #2 13,333 15,151 13,333 15,580 11,944 15,580
38,095 43,290 38,095 44,515 34,125 44,515
22
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
12
Budgeting
• Visits Should drive Medical Supply and Transportation CostsMedical Supply cost per Visit# of Miles Per Visit Times Reimbursement Per Mile
• Revenue Indicators will drive Indirect FTE requirementsExamples
• Clinical Supervisor• Patient Accounting• Performance Improvement• Intake• Coding• Etc.
23
Budgeting
• Monitor current results to budgeted expectationsShare these results each month with the stakeholdersKnow what the variances mean
24
Pre-Conference 2701. Home Health Summer Camp 2013Feasibility Analysis Practices
July 28, 2013
13
PROPERTY OF SIMIONE HEALTHCARE CONSULTANTS25
SIMIONE.COM
Simione™ Healthcare Consultants provides solutions for your core homecare and hospice challenges – organizational, financial, sales & marketing,technology, and mergers & acquisitions. Over 1000 organizations use ourpractical insight and tools to reduce costs, mitigate risk and improveefficiencies to steward the way they conduct business.
William J. Simione, III4130 Whitney AvenueHamden, CT 06518
203.287.9288800.949.0388